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KSB-KLAC Dual Membership
Keilor-St.Bernard's Athletic Club & Keilor Little Athletics Centre Dual Membership Registration
First Name *
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Family Name *
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Sex *
Address *
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Phone *
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email *
Your answer
Are you a current member of Keilor Little Athletics Centre? *
What age group will you compete in during the 2016/17 season? *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Relationship to Athlete *
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Emergency Contact Phone *
Your answer
Please outline any relevant medical conditions and/or allergies (if applicable)
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Your preferred event(s) *
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